You may want to check with your insurance company. Call the 1-800 number on your card and ask the representative. In my experience, insurance may cover removal of ruptured silicone implants even if it was originally placed for cosmetic reasons. They will not pay for replacement of the implant or removal of the other side if it is not ruptured. I would recommend you see a Plastic Surgeon who is Board-certified by the Am Board or Plastic Surgery and he/she can help you figure out the best options for you, but don't ignore it, especially if you are foregoing your mammograms and breast screening as a result of this rupture.
With the newer techniques available for breast reconstruction, more of my patients are eligible for immediate reconstruction. My patient find that when they have immediate reconstruction, they wake up with a breast or at least a head start on breast reconstruction. Even my patients who choose tissue expanders can now wake up with a breast that is almost the same size as their previous breast with the newer techniques that are available. My patients tell me that this makes such a difference, psychologically. In addition, in patients who have had previous radiation or will have radiation and are planning to have tissue expanders, immediate reconstruction offers probably the best chance that a tissue expander/implant reconstruction will be successful. Radiation affects your skin's ability to stretch and a delayed recosntruction would require that the skin be restretched which has been shown to have afailure rate of up to 50%. If you are choosing a flap reconstruction and will have radiation, then I would recommend waiting for your reconstruction until after your radiation. You don't want to radiate you nice new reconstruction and cause scarring and distortion.
Radiesse should not be used in the lips. I routinely use Juvederm for the lips. It is much softer, pliable and less likely to cause lumps and nodules compared to Radiesse.
If you are denied from your insurance company for dermal matrix in your breast reconstruction, call them and ask why it is being considered experimental. What criteria are they using? Do they pay for another brand of dermal matrix (Alloderm is one brand of dermal matrix). Here in California, for instance, Anthem Blue Cross will only cover Alloderm and considers all other brands experimental (?!). Once you gather this information, file an appeal. There are many published articles regarding the dermal matrix and its use in post-mastectomy reconstruction. Dermal matrix, while not absolutely necessary per se has a number of advantages: For example: 1) Dermal matrix may lead to less pain. If dermal matrix is not used, your plastic surgeon may have to raise another muscle (the serratus muscle) to cover a part of your implant. 2) Dermal matrix may lead to fewer implant contractures. There is some emerging evidence that dermal matrix use around implants may decrease contractures (hardening) around implants. 3) Dermal matrix allows for more fill in the operating room. Most of the breast reconstruction that I do is done at the time of the mastectomy. In those instances, use of the dermal matrix allows me to fill the tissue expander more, so that you'll get more of a head start and need fewer fills in the office after the operation. Also, psychologically, it is less traumatic for my patients to wake up with a breast with significant volume in it. Some have even been happy enough not to get filled any further after the operation. 4) Dermal matrix allow for better shape and inframammary fold definition. The dermal matrix can be fixed to your chest wall to help recreate your fold that can be blunted after a mastectomy. Also the release of your muscle and placement of the dermal matrix allows for better expansion of the lower pole of your new breast which will make it look more natural. 5) Dermal matrix may allow for better results in radiation patients. In the past, patients who have had radiation or planning to have radiation were advised against having tissue expanders/implants. However, when the reconstruction is done at the same time as the mastectomy, it allows for more expansion in the operating room, less contracting of the skin, and so far for me, better results in patients I would have tradtitionally steered toward a TRAM or other big flap. Hopefully you can cite some of these advantages in your appeal. Good luck!
I have my patients go to the store and try on different bras at the store. Remember that you can only change the bra cup size not the band size, so if you are a 34A, you should try 34B-C-D not 36. Stuff the bra you pick and wear the bra for a few days in different clothes and see if that is really what you want. Then bring it to the office, and I would size you to see how big of an implant would be needed to achieve that size. Depending on the your size and the size of the implant desired, we then discuss if what you have chosen is a good fit for you. The size you can have is limited by the:
